Gout management: Recognising and treating acute attacks

In his latest online article, Dr Taher Mahmud delves into the world of gout, exploring its classical features, treatment options, and more, as he guides you towards better gout management.

Understanding acute gout:

Acute gout is a form of arthritis characterised by sudden and severe pain, redness, and tenderness, typically affecting the big toe. It occurs when urate crystals accumulate in the joint, causing inflammation and intense discomfort. Recognising its classical features is crucial for effective management.

Recognising classical features:

Managing gout begins with identifying its classical features, which include:

Sudden onset of pain: Gout attacks strike unexpectedly and escalate rapidly. 

Swelling and redness: Affected joints undergo swelling, become red, and exhibit heightened sensitivity.

Warmth: The inflamed joint can feel warm to the touch.

Limited mobility: Pain and swelling can restrict joint movement.

Night attacks: Gout attacks often disrupt sleep by occurring at night.

NSAIDs or steroids: Choosing the right treatment:

When a gout attack strikes, prompt pain relief is essential. The two primary options for managing gout pain are nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.

NSAIDs:

NSAIDs, such as ibuprofen and naproxen, are commonly used to alleviate gout symptoms. They work by reducing inflammation and pain. However, cautious use under medical supervision is vital, as excessive or prolonged use may lead to side effects.

Steroids:

Steroids, like prednisone, can also provide relief from acute gout attacks by suppressing the immune system's response to urate crystals. In severe cases, a short course of steroids may be prescribed.

The role of proton pump inhibitors (PPIs):

When using NSAIDs, it's advisable to combine them with proton pump inhibitors (PPIs) to reduce the risk of gastrointestinal complications. PPIs, such as omeprazole, protect the stomach lining and prevent issues like ulcers.

Long-term management with uric acid altering medicines: 

If you've had gout flare-ups more than three times in the past three years, it's a good idea to think about a long-term solution. Medications like allopurinol can lower uric acid levels in the blood, reducing the frequency and severity of gout attacks. This option is typically considered when acute gout attacks become recurrent.

When to seek help:

It's essential to remember that gout can lead to complications if left untreated or improperly managed. If you experience recurrent gout attacks or are unsure about the best course of action, consult with a healthcare professional.

Dr Taher Mahmud is a highly regarded rheumatologist with over 30 years of experience. You can schedule an appointment with Dr Mahmud on his Top Doctors profile.